Women's Experiences of Living With Maternal Mental Health Conditions and Accessing Maternal Mental Health Services in Aotearoa New Zealand

Abstract

Background: Maternal mental health (MMH) conditions affect 12-18% of women in Aotearoa New Zealand, with suicide being a leading cause of maternal death in the perinatal period. The intersection of social, psychosocial and health issues increases complexity in care requiring a multi-faceted approach. In New Zealand no formal national screening programme for MMH exists and the availability of guidance for best practice is variable.

Aim: To examine the experiences of a group of women who have been diagnosed with maternal mental health conditions and have accessed MMH services.

Method: This qualitative study was guided by Thorne's interpretive description methodology. Seven women who had been diagnosed with MMH conditions in the Canterbury region of New Zealand participated in the study. Criteria for the study were that they had had a baby within the period 2020-2022 (during the COVID-19 pandemic); were not at that time pregnant or within the six-week postpartum period; had been referred to, or had accessed, MMH services; and had not required a transfer to obstetrician-led or psychiatric-led care. Semi-structured interviews were conducted to understand their experience. Findings: Four main themes were identified: Lifestyle challenges such as preparing for parenthood, external factors and perinatal experiences; The impact of relationships such as whether they were helpful or unhelpful; Burden carrying, including being labelled as a bad mother, self-blame and needing advocacy from support people; and Logistics of access, including the impact of education, barriers to accessing care and the experience of services.

Discussion: The findings acknowledge the impact that education, screening and referral to MMH services have on women. By the women being better prepared for parenthood, and by open discussion about MMH conditions being encouraged, the stigma felt by new mothers could be reduced. The study highlights that midwives are in a good position to screen and educate women about MMH conditions. Despite this being a small regional qualitative study, findings clearly indicate how consideration must be made to addressing barriers to accessing care, to fostering collaboration amongst health professionals, and to providing midwives with compulsory New Zealand-specific MMH education and screening tools. As this was a small study in one region, further countrywide research in this domain is urgently required.

Conclusion: This study concludes that midwives play a crucial role in MMH care through education, screening and referral. Addressing barriers to care and standardising screening tools can improve quality and accessibility of MMH services and improve health outcomes for New Zealand women.